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Objectives Vitiligo is a widespread cutaneous disorder. The present study aims to evaluate the epidemiologic profile of vitiligo and investigate its different clinical forms, disease activity, hereditary associations, triggering factors, and probable association with other diseases. Methods This prospective observational study was conducted over one year, from 2019 to 2020, and included 120 cases demonstrating definite clinical evidence of vitiligo. All selected patients underwent a detailed medical history interview. Specific enquiries were made regarding precipitating factors, clinical features of the disease, histories of other autoimmune diseases, and family histories. Thorough clinical, laboratory, and cutaneous examinations were performed on all patients. Descriptive statistical methods and diagrams were used to summarise the data. Results The age at presentation (31 patients, 25.8%) and the onset of the disease (32 patients, 26.6%) was predominantly in the second decade of life. The condition was usually progressive, with vitiligo vulgaris being the most prevalent type (56 cases, 46.7%). Disease onset (37 individuals, 30.8%) and the prevalence of lesions were higher in the lower leg. Body surface area involvement was ≤1% in 72 (60.0%) patients. Itching and trauma were the typical initiating factors. Leukotrichia in 38 (31.7%) cases, Koebner's phenomena in 23 (19.1%) cases, and a positive family history in 26 (21.7%) cases were observed. Thyroid dysfunction, hypertension, and various skin conditions are associated with the disease. Conclusion Vitiligo is more common in the young population. The condition is often progressive, with vitiligo vulgaris being the most common type. Itching and trauma are frequent initiating factors. Monitoring patients for associated diseases may be crucial for diagnosis and treatment outcomes.
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BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.
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Coexistence of bullous pemphigoid (BP) and vitiligo vulgaris (VV) is very rare. We present a unique case of BP associated with VV in a 76-year-old Japanese man, in which BP eruption developed exclusively on preexisting VV regions. The patient was referred to us with a 3-month history of blistering eruption with severe pruritis on the right forearm and left lower limb. In addition, he had been suffering from a widespread depigmented eruption on the trunk and extremities for at least 20 years. Curiously, the blistering eruption developed exclusively on preexisting depigmented eruption. Histopathological and laboratory examinations identified the blistering eruption as BP. The depigmented eruption was diagnosed as VV. BP eruption responded quickly to oral prednisolone therapy, improving within 1 week, and the prednisolone dose was gradually tapered. Within 1 month, BP lesions almost completely resolved. In the present case, BP not only coexisted with VV, but also developed exclusively on preexisting vitiliginous regions. The present case strongly suggests that BP and VV are partly caused by common pathological mechanisms.
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BACKGROUND: Alopecia areata and vitiligo vulgaris are common autoimmune diseases whose pathophysiology are not completely elucidated. Genetic susceptibility, immunological background, and stress have significant roles in their pathogenesis. Although macrophage migration inhibitory factor (MIF) is crucial for the maintenance of immune privilege in certain sites, it can upregulate different inflammatory cytokines and contribute to the pathogenesis of different autoimmune diseases. There is controversy about its role in alopecia and no adequate data about its role in vitiligo. OBJECTIVES: We sought to assess the serum level of MIF in alopecia areata and vitiligo and its relationship with different variables of both diseases. METHOD: Serum level of MIF was measured in 20 patients with vitiligo, 22 patients with alopecia areata, and 20 controls by ELISA. RESULTS: MIF was significantly higher in alopecia areata (8.477±4.1761ng/mL) and vitiligo vulgaris (3.930±2.7071ng/mL) compared to controls (0.725±0.5108 ng/mL) (P<0.01). In addition, MIF levels were positively correlated with the severity of alopecia areata and vitiligo. CONCLUSION: The MIF has an active role in the pathogenesis of alopecia areata and vitiligo and could be a target for the treatment of both diseases.
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BACKGROUND: We studied clinico-epidemiological features of 945 patients with vitiligo with an objective to delineate epidemiological and clinical aspects of vitiligo from this part of the country. MATERIALS AND METHODS: The medical records of patients with vitiligo attending outpatient clinic over a 5-year period from January 2013 to December 2017 were analyzed retrospectively for this descriptive, observational study. RESULTS: There were 449 men and 496 women (m:f 1:1.1) aged between 2 and 83 years (mean 24.4 years) and having vitiligo for 1 week to 64 years (mean 5.1 years). The majority, 478 (50.6%) patients were aged ≤20 years and 248 (26.2%) were children aged ≤12 years. The age at the onset was between 6 months and 82 years (mean 20.5 years), and the majority 674 (71.3%) patients had it before 25 years of age. The consultation time was within 5 years in 692 (73.2%) patients. A family history of vitiligo was present in 150 (15.9%) patients. The majority 871 (92.2%) patients had involvement of up to 10% body surface area and vitiligo vulgaris in 562 (59.5%) and focal vitiligo in 117 (18.7%) patients were the most common clinical types. An association with other systemic disorders was in 124 (13.1%) patients and predominately included thyroid abnormalities and diabetes mellitus. CONCLUSIONS: Our observations are essentially consistent with the literature. There was no difference in clinico-epidemiological features of vitiligo. Patients with an affected first-degree family member had early onset, but difference was not statistically significant. Screening for concurrent thyroid disorders appears important. However, our inferences remain limited by single center, retrospective, observational, and cross-sectional nature of the study.
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Vitiligo is a disorder causing skin depigmentation, in which several factors have been proposed for its pathogenesis: Environmental, genetic and biological aspects of melanocytes, even those of the surrounding keratinocytes. However, the lack of understanding of the mechanisms has complicated the task of predicting the development and progression. The present study used microarray analysis to characterize the transcriptional profile of skin from Vitiligo Vulgaris (VV) patients and the identified transcripts were validated using targeted high-throughput RNA sequencing in a broader set of patients. For microarrays, mRNA was taken from 20 skin biopsies of 10 patients with VV (pigmented and depigmented skin biopsy of each), and 5 biopsies of healthy subjects matched for age and sex were used as a control. A signature was identified that contains the expression pattern of 722 genes between depigmented vitiligo skin vs. healthy control, 1,108 between the pigmented skin of vitiligo vs. healthy controls and 1,927 between pigmented skin, depigmented vitiligo and healthy controls (P<0.05; false discovery rate, <0.1). When comparing the pigmented and depigmented skin of patients with vitiligo, which reflects the real difference between both skin types, 5 differentially expressed genes were identified and further validated in 45 additional VV patients by RNA sequencing. This analysis showed significantly higher RNA levels of calpain-3, dopachrome tautomerase, melan-A and tyrosinase-related protein-1 genes. The data revealed that the pigmented skin of vitiligo is already affected at the level of gene expression and that the main differences between pigmented and non-pigmented skin are explained by the expression of genes associated with pigment metabolism.
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Rhododendrol-induced leukoderma is an acquired depigmentation that develops mainly at the contact site after repeated use of skin-whitening cosmetics containing rhododendrol. In most cases, cessation of further depigmentation or occurrence of repigmentation is observed after discontinuing the use of cosmetics. However, some patients develop vitiligo vulgaris through the spread of depigmentation into the non-exposed areas. Our study aims to investigate the patient-specific factors that may affect the extent of depigmentation or repigmentation, as well as development of vitiligo vulgaris. The degree of depigmentation of the face, neck and hands where exposed to rhododendrol was scored using photographs over time. The relationships between depigmentation score at first visit/improvement rate of depigmentation score and patient demographics were evaluated and three important clinical observations were made. First, repigmentation of the face was superior compared with that of the hands and neck, suggesting a possible role for the migration and differentiation of melanocyte stem cells from hair follicles, as a mechanism of repigmentation. Second, the intensity of rhododendrol exposure did not contribute to differences in the severity of depigmentation. This suggested a possibility of underlying genetic susceptibility to melanocyte cytotoxicity or immune reaction. Third, depigmentation score at first visit and past history of atopic dermatitis were significantly high in patients who developed vitiligo vulgaris. This suggested that severe chemical damage of melanocytes by rhododendrol leads to a higher risk of developing vitiligo vulgaris through the possible involvement of an immune reaction. These clinical observations may help to further understand the pathogenesis of rhododendrol-induced leukoderma.
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Butanoles/efectos adversos , Enfermedades de la Piel/inducido químicamente , Pigmentación de la Piel/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades de la Piel/epidemiología , Adulto JovenRESUMEN
Vitiligo is a refractory skin disease. To investigate the risk factors and treatment responses of patients with vitiligo in Japan, we recorded and analyzed the details of 713 vitiligo patients (comorbidity, treatment responses, family history, age, and sex) who visited the dermatology clinic of the Nagoya City University Hospital, Nagoya, Japan between January 2004 and August 2010 (mean age, 35.2 years; 302 men, 411 women) using logistic regression analysis. The results are expressed as odds ratios (OR) with 95% confidence interval (CI). Patients were diagnosed with vitiligo [n = 644; 338 generalized type (47.4%), 170 segmental type (23.8%), and 136 localized type (19.1%)], nevus depigmentosus (n = 53, 7.4%), halo nevus (n = 14, 2.0%), and hypomelanosis of Ito (n = 2, 0.3%). For generalized and localized types, none of the analyzed factors were statistically significant. For the segmental type, antinuclear antibody (OR = 1.005; 95% CI, 1.00-1.01; p < 0.05) and onset age < 14 years were the significant factors in patients between 15 years and 29 years (OR = 0.246; 95% CI, 0.113-0.538; p < 0.001), 30-54 years (OR = 0.0419; 95% CI, 0.0133-0.132; p < 0.001), and >55 years (OR = 0.0171; 95% CI, 0.00333-0.0879; p < 0.001). The treatment response rates for narrow-band UV-B, topical vitamin D3, and punch graft (1 mm minigraft) were, respectively, as follows: (1) generalized type: 46.3%, 21.1%, and 38.9%; (2) segmental type: 20.3%, 29.0%, and 77.3%; and (3) localized type: 29.2%, 54.8%, and 73.3%. We report the comorbidities and efficacy rates of these treatments. The response data for these treatments, in particular, would be of assistance to the previous explanations, because there were only a few reports on the response data for these treatments. The appropriate treatment should be selected depending on the type of vitiligo.
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Vitíligo/epidemiología , Adolescente , Adulto , Colecalciferol/uso terapéutico , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Vitíligo/tratamiento farmacológico , Vitíligo/terapia , Adulto JovenRESUMEN
Melanocyte loss in vitiligo vulgaris is believed to be an autoimmune process. Macrophage migration inhibitory factor (MIF) is involved in many autoimmune skin diseases. We determined the possible role of MIF in the pathogenesis of vitiligo vulgaris, and describe the relationship between MIF expressions and disease severity and activity. Serum MIF concentrations and mRNA levels in PBMCs were measured in 44 vitiligo vulgaris patients and 32 normal controls, using ELISA and real-time RT-PCR. Skin biopsies from 15 patients and 6 controls were analyzed by real-time RT-PCR. Values are reported as median (25th-75th percentile). Serum MIF concentrations were significantly increased in patients [35.81 (10.98-43.66) ng/mL] compared to controls [7.69 (6.01-9.03) ng/mL]. MIF mRNA levels were significantly higher in PBMCs from patients [7.17 (3.59-8.87)] than controls [1.67 (1.23-2.42)]. There was also a significant difference in MIF mRNA levels in PBMCs between progressive and stable patients [7.86 (5.85-9.13) vs 4.33 (2.23-8.39)] and in serum MIF concentrations [40.47 (27.71-46.79) vs 26.80 (10.55-36.07) ng/mL]. In addition, the vitiligo area severity index scores of patients correlated positively with changes of both serum MIF concentrations (r = 0.488) and MIF mRNA levels in PBMCs (r = 0.426). MIF mRNA levels were significantly higher in lesional than in normal skin [2.43 (2.13-7.59) vs 1.18 (0.94-1.83)] and in patients in the progressive stage than in the stable stage [7.52 (2.43-8.84) vs 2.13 (1.98-2.64)]. These correlations suggest that MIF participates in the pathogenesis of vitiligo vulgaris and may be useful as an index of disease severity and activity.